HomeMy WebLinkAboutWINTERS ELECTRIC INC - INSURANCE CERTIFICATE (2)WINTE-4 OP ID: JM
'a�a►Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
10/23/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
NTAPRODUCER Phone: 719-590-9990 NAME: CT Jonna Hayes
Co
Six & Geving Insurance, Inc. Fax: 719-590 9992 PHONE 719-867-4506 FAX No : 719-590-9992
3630 Sinton Road, Suite 200 A/c No Ext : _
Colorado Springs, CO 80907-5034 ADDRess: jhayes@six-geving.com
James L. Bussanich
INSURER A: Auto -Owners Insurance Co. 18988
INSURED Winters Electric Inc INSURER B:Plnnacol Assurance 41190
139 Winters Dr
Colorado Springs, CO 80907 INSURER c
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE Nl1MSER: REVISION Nl1MRER-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
DL
BR
POLICY NUMBER
EFF
MM/DD/YYYY
Y EXP
MMIDDPOLICY
/YYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FxI OCCUR
74195283
10/24/2015
10/24/2016
EACH OCCURRENCE
$ 1,000,00
DAMAGE T RENTED
PREMISESOE occurrence
$ 300,00
MED EXP (Any one person)
$ 10,00
PERSONAL & ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY I X PRO LOC
PRODUCTS - COMP/OP AGG
$ 2,000,00
$
A
AUTOMOBILE LIABILITY
ANY AUTO
SCHEDULED
AUTOS AUTOS
ALL OWNED Ix
X HIRED AUTOSNON-OWNED
AUTOS
4819528300
10IW2015
10/24/2016
COEa aMBINED SINGLE LIMITccident
11000,00
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
$
PROPERTY DAMAGE
Per accident
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
4819528301
10/24/2015
10/24/2016
EACH OCCURRENCE
$ 1,000,00
AGGREGATE
$ 1,000,00
DIEDX RETENTION $ 10000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
4118326
10/01/2015
10/01/2016
X I WC STATU- OTH-
T RY LIMIT R
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE - EA EMPLOYEE,
$ 1,000,00
E.L. DISEASE - POLICY LIMIT
1 $ 1,000,00
A
Equipment Floater
74195283
10/24/2015
10/24/2016
Rented 50,00
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Electrical Wiring
CERTIFICATE HOLDER CANCELLATION
CITYFOR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
Fort Collins, CO 80526 AUTHORIZED REPRESENTATIVE
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD